Barkun A N, Ponchon T
Montreal General Hospital, Quebec, Canada.
Ann Intern Med. 1990 Jan 15;112(2):126-37. doi: 10.7326/0003-4819-112-2-126.
To identify the technical and physical principles of extracorporeal biliary lithotripsy that are clinically relevant, and to review the patient series published to date.
Studies published since 1983 identified through a computerized search of MEDLINE and extensive hand searching of bibliographies in identified articles.
Twenty-nine studies done in vitro or in animals and 21 studies in humans assessing biliary lithotripsy.
Based on an understanding of experimental determinants of fragmentation, we assess and explain the differences in the results from the clinical studies. The conclusions concerning overall clinical efficacy and safety are emphasized.
Extracorporeal shock waves will safely fragment the gallstones of 80% to 100% of selected patients. However, the rate of satisfactory fragmentation (defined as the persistence of fragments only 3 to 5 mm in diameter or less) varies widely among the studies (22% to 78%); this discrepancy depends partly on differing characteristics of stone populations. For patients presenting with solitary stones of 20 mm in diameter or less, 90% will be stone-free within 6 to 9 months after lithotripsy; moreover, the success of lithotripsy determines the rapidity and extent of fragment dissolution. Bile-duct-stone lithotripsy is reserved for patients in whom endoscopic stone extraction and intracorporeal lithotripsy, with or without direct contact dissolution, have failed. Lithotripsy achieves ductal clearance in 55% to 85% of patients.
Extracorporeal lithotripsy is safe and effective in selected patients, and has a definite role to play in managing patients with biliary stone disease. Its role in the coming years will depend on technical improvements in the generators, a tailored approach to complementary dissolution or extraction, and effective prophylactic therapy for preventing gallstone recurrence.
确定与临床相关的体外胆道碎石术的技术和物理原理，并回顾迄今已发表的患者系列研究。
通过计算机检索MEDLINE以及对已识别文章的参考文献进行广泛手工检索，确定自1983年以来发表的研究。
29项体外或动物实验研究以及21项评估胆道碎石术的人体研究。
基于对结石破碎实验决定因素的理解，我们评估并解释临床研究结果的差异。强调关于总体临床疗效和安全性的结论。
体外冲击波能安全地破碎80%至100%选定患者的胆结石。然而，满意破碎率（定义为仅残留直径3至5毫米或更小的碎片）在各研究中差异很大（22%至78%）；这种差异部分取决于结石群体的不同特征。对于直径20毫米或更小的单发结石患者，90%在碎石术后6至9个月内结石清除；此外，碎石术的成功决定了碎片溶解的速度和程度。胆管结石碎石术适用于内镜取石和体内碎石术（无论有无直接接触溶解）均失败的患者。碎石术使55%至85%的患者实现胆管清除。
体外碎石术在选定患者中安全有效，在胆管结石病患者的治疗中具有明确作用。其在未来几年的作用将取决于发生器的技术改进、针对辅助溶解或取石的个性化方法以及预防胆结石复发的有效预防性治疗。
